Introduction to Pathophysiology

Dr. Danielle Webster

 What is Pathology?
• The study (logos) of disease (pathos, suffering)
• Investigates:
– Causes of disease
– Associated changes at the levels of
• Cell
• Tissues
• Organs
– This gives rise to the presenting signs and
symptoms
 What is Pathophysiology?
• Physiology
– Study of functions of living organisms

• PATHOPHYSIOLOGY
– Study of the abnormalities in physiological
functions
– Responses to disruptions in homeostasis
– Common and classic presentations of
disorders
 Two important terms you will
encounter
• Etiology
– Origin of disease
– Underlying causes and modifying factors
• Genetic or environmental
• Pathogenesis
– Steps in the development of disease
– How the etiological factors trigger cellular and
molecular changes
– Structural and functional abnormalities that
characterize the disease
 Pathology the discipline

General Pathology Systems Pathology

Cellular and tissue Reactions and

alterations caused by abnormalities of
a pathological stimuli specialized organs

Identify changes in response to injury

 FRAMEWORK FOR
PATHOPHYSIOLOGY
• Etiology

• Pathogenesis

• Clinical manifestations

• Treatment implications
 Etiology: WHY the diseases arises
• Study of the causes or reasons for the
phenomena

• Identify the causal factor

– Idiopathic
– Iatrogenic
– Causative agent

• Most disorders are multifactorial

– Genetic or environmental factors
– Host factors influence

• Risk factors
Etiologic Classification of Diseases
Congenital diseases or birth defects
Degenerative diseases
Iatrogenic diseases
Idiopathic diseases
Immunological diseases
Infectious diseases
Inherited diseases
Metabolic diseases
Neoplastic diseases
Nutritional deficiency diseases
Physical agent-induced diseases
Psychogenic diseases
 Pathogenesis: HOW the disease
develops
Initial stimulus Ultimate expression of
manifestations of disease

• How etiological factors alter physiological

function?

• Development of clinical manifestations

 Clinical Manifestations
• Observed as signs and
symptoms

– Signs are objective changes

that a clinician can observe and
measure; e.g., fever or rash.

– Symptoms are subjective

changes in body functions that
are not apparent to an
observer; e.g., headache or
nausea.

– Syndrome: when etiology of

signs/symptoms are not
determined
 Stages and Clinical Course
Latent or incubation period
-No recognition by patient, lab tests may detect

Prodromal period/Prodrome
-appearance of first signs/symptoms (non-specific)

Subclinical phase
-patient functions normally although disease
well established

Manifest illness/Acute phrase

-signs/symptoms at greatest severity
 Acute vs Chronic Conditions
Acute Condition Chronic Condition
• Severe manifestations for a • Lasts for months to years
short time
– Hours  a few weeks

Acute Chronic

OR
Chronic Acute
 Course of disease
• Exacerbations
– Sudden increase in severity
• Remissions
– Decline or abatement in severity
• Convalescence
– Stage of recovery after disease, injury or surgery
– Sequela
• Subsequent pathological condition
OR
• Secondary process arise because of original problem (new
complication)
 Treatment Implications
• Understanding causes and processes imply
certain treatment

• Understanding what you are treating and

what effects and results you desire to attain
imply treatment.
CONCEPTS OF NORMALITY IN HEALTH
• Ability to determine normal function vs.
abnormal function
– Sometimes there are direct observations
– Sometimes subjective based on examiner

• Clinical examination is not sufficient

• Must also undergo diagnostic testing
 Statistical Normality

Estimate of diseases in a normal population, based on a

bell-shaped curve
 Reliability, Validity and Predictive
Value

• Accuracy of determination of presence or

absence of disease depends on:
– Quality and adequacy of data collected
– Skill of interpretation
– Hypothesis first  lab tests to refine prediction
 Reliability, Validity and Predictive
Value
• Reliability
– Ability of a test to give the same result in repeated
measurements
• Validity
– Degree to which a measurement reflects the true
value of what it intends to measure
• Predictive Value
– Extent to which the test can differentiate between the
presence or absence of a condition
• Positive predictive value
• Negative predictive value
 Sensitivity and Specificity
• Sensitivity: probability that a test will be
positive when applied to a person with a
particular condition

• Specificity: probability that a test will be

negative when applied to a person without a
particular condition
 Individual Factors
• Cultural considerations
– health and illness reflects each cultures experience

• Age differences
– Hair color, skin turgor, organ size

• Gender differences
– Hemoglobin concentrations, serum creatine levels

• Situational differences
Deviation from normal should be considered abnormal or an adaptation
mechanism

• Time variations
– Body’s response from day to night, or at varying times
 CONCEPTS OF EPIDEMIOLOGY
• Epidemiology
– Study of patterns of disease

• Examine:
– Occurrence
– Prevalence
– Transmission
– Distribution among population
 CONCEPTS OF EPIDEMIOLOGY
• Endemic disease
– Native to a local region
– Always present in a certain population
– Malaria

• Epidemic disease
– Outbreak spreading rapidly/extensively
through a population
– Affecting an atypically large amount of
people within a population
– Smallpox, Typhus

• Pandemic disease
– Worldwide epidemic
– spread to large geographic areas
– Polio in the 50’s, TB after WWI, AIDS, SARS
 Factors affecting patterns of disease
• Age
– Developmental  maturity  postmaturity

• Ethnic group
– Sickle cell anemia vs. pernicious anemia

• Gender
– Endometriosis (women), hyperplasia of the prostate (men)

• Socioeconomic factors and lifestyle conditions

– Obesity vs. malnutrition

• Geographic location
– Malaria, African sleeping sickness
 Levels of Prevention
Treatment implications fall into categories of
prevention
• Primary prevention
– Altering susceptibility or reducing exposure
• Secondary prevention
– Early detection, screening and management
• Pap smear
• Tertiary prevention
– Medical and surgical
– Rehabilitation, supportive care, attempts to alleviate
disability and restore function
 SUMMARY FOR TODAY
• What is Pathophysiology?
• What is the framework for Pathophysiology?
– Etiology, Pathogenesis, Clinical Manifestations,
Treatment
• Normality in health and disease
• Epidemiology
– Who is affected?
– What are the levels of prevention